Objective: As the era of free tissue transfer for head and neck reconstruction matures, more patients are requiring second resections and reconstructions. Our objective was to evaluate: patient characteristics, reconstructive options, flap survival, perioperative morbidity, and mortality. Study Design: Retrospective chart review. Subjects and Methods: Sixty-five patients underwent a second free tissue transfer separate from the time of the primary flap. Results: The most common (53%) reason for a second flap was tumor recurrence. The most common flaps used were radial forearm and fibula in both the first and second reconstructions. Larger flaps were used in the second reconstruction. Inhospital mortality was 4.6 percent; medical complications occurred in 5 percent of patients. Flap survival was 97 percent; 13 percent of second flaps returned to the operating room for complications. Eight patients had a third free flap. Conclusion: A second free tissue transfer is a viable resource in head and neck reconstruction. Acceptable rates of flap survival and complications are encountered.
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